This application is submitted in response to RFA HS-03-001 from the Agency for Healthcare Research and Quality (AHRQ). The Center for the Evaluative Clinical Sciences (CECS) at Dartmouth received an institutional NRSA award from the AHCPR in 1994. The applicants are submitting this competing continuation application requesting funding for the next five years to teach the measurement, organization and improvement of health care. They believe that this is an excellent opportunity to advance the goals of both CECS and AHRQ. CECS's pre- and postdoctoral programs are designed to provide rigorous preparation in the disciplines and methods needed to carry out research on the outcomes and effectiveness of health care and to become effective "change agents" to lead improvements in health care. The programs supported by NRSA funding are designed specifically to produce well-trained researchers who are thoroughly familiar with the clinical, methodological, and policy issues in assessing the effectiveness of health care. These pre- and postdoctoral programs in the evaluative clinical sciences include Master of Science (initiated 1993): 298 graduates, 50 enrolled; Master of Public Health (initiated 2002): 36 enrolled; Doctor of Philosophy (initiated 1994): 8 graduates, 13 enrolled; NRSA postdoctoral research training (initiated 1995): 2 enrolled; VA Outcomes Research Fellowship (initiated 1991): 5 enrolled; VA Quality Scholars Fellowship (initiated 1999): 3 enrolled. Among these 6 programs, the Ph.D. and 2 postdoctoral programs (NRSA and Outcomes Research) focus on training independent scientists and build on the extensive ongoing research programs of the Dartmouth faculty. Ph.D. students complete course work and research requirements for a Ph.D. degree in the evaluative clinical sciences, under the Office of Graduate Studies at Dartmouth. NRSA Postdoctoral Fellows work closely with a faculty mentor, with an emphasis on participation in ongoing research projects, and they complete an individualized program of course work, its content determined by the trainee's background. The overall aim of the NRSA-funded programs is to train individuals who will contribute meaningfully as academics and researchers to the multidisciplinary field of health services research and/or health policy, with a particular emphasis in effectiveness research. [unreadable] [unreadable] [unreadable]